U.S. Doctors Behind Face Transplants Give Details of Procedure

Long, painstaking surgery has so far only been done on 18 patients worldwide.

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WEDNESDAY, Dec. 28, 2011 (HealthDay News) —
Full face transplants were once the stuff of science fiction, but not anymore.

So far, 18 such transplants have been done worldwide, and U.S.
surgeons describe the intricate procedures in the Dec. 28 online edition of the
New England Journal of Medicine.

The article details the stories of three face transplants that were
performed at Boston's Brigham & Women's Hospital in 201l, including the much-publicized
case of Charla Nash, who lost most of her face in a chimpanzee
attack.

While some technical challenges remain, surgeons say they are
getting better and better at performing face
transplants.

"We don't know how common or rare this operation will be, but
it is here to stay," said Dr. Bohdan Pomahac, the director of the plastic
surgery transplantation program at Brigham & Women's. He was the lead
surgeon on all three cases described in the journal report.

These lengthy and complex surgeries are reserved for individuals
with severe facial
deformities, but as techniques and technology improve, transplants
could become an option for patients with lesser degrees of facial deformity.

Who's a candidate? According to the doctors, prospective recipients
first undergo extensive medical and psychological evaluation. If they are
deemed to be appropriate candidates, surgeons then begin their search for
suitable donors and start to plan the surgery.

Each operation is unique and can take more than 20 hours to
complete. In general, surgeons will first remove any non-viable or injured
tissue from the face transplant recipient. The healthy tissue, once procured
from suitable donor, is then attached. This is not a simple task —
surgeons must restore blood flow, reattach nerves, muscles and bony structures,
and then reconnect each layer of the new face.

Even so, "the hardest part is the recovery of the donor
face," Pomahac said. After the transplant is complete, surgeons must be on
the lookout for any signs of rejection and other side effects, such as
infection. These risks are highest during the first 24 hours after surgery.
"There can be clotting in the vessels that are re-connected, and we use
high doses of immune suppression for a first couple of days so the patient is
more susceptible to infection," he explained.

In the beginning, the patient's new face is swollen and has no
motion. "Most of the swelling goes down in six weeks and then you regain
motor function in three to six months," he said. Many of these patients
are eating within a few days. "They get better and better each time we see
them," he said.

Unlike in the movies, the patient does not
wake up with the face of the donor, Pomahac stressed. Instead, the new face is
more of a hybrid between donor and recipient. "It is surprisingly easy to
get used to," he said. "They have new faces, but they still have a
way of speaking and have the same body language."

Another study author , Dr. Daniel S. Alam, is the head of the
section of facial aesthetic and reconstructive surgery in the Head and Neck
Institute at the Cleveland Clinic in Ohio. He said the new article is important
because it is the first time face transplants have been reported as a series of
cases.

Alam was involved with Nash's surgery, and also performed the first
U.S. face transplant — on gunshot victim Connie Culp, in December of
2008.

"Five years ago, we didn't know if this could be done. Full
face transplants can be done technically, they can be done safely and patients
can get a lasting benefit," he said. The new study's publication marks
"the end of the first chapter and now we need Chapter Two, to see who is
the right patient and work toward making the surgery better and better,"
Alam said.

That remains a work in progress. "Surgeons have been taking
gall bladders out for years [for example], but we are extremely early in our
learning curve for face transplants," he said.

Another expert agreed.

"Face transplants are here to stay," said Dr. Edwin F.
Williams III, a facial plastic surgeon in Albany, N.Y., and vice president of
public affairs at the American Academy of Facial Plastic and Reconstructive
Surgery.

However, he added, "we really need to move
forward carefully and they won't be something that happen in every
small town and city."

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